Fluid Retention is Alleviated by Crystalloid but Not by Colloid Fluid after Induction of General Anesthesia: An Open-Labeled Clinical Trial

Hahn, Robert G.; Li, Yuhong

doi:10.4172/2155-6148.1000597

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…3c). The theoretical importance of this process of is that patients with a low habitual intake of water might have their urine so much more concentrated during the surgery that the concentrating capacity of the kidneys is exceeded, which causes a postoperative rise in plasma creatinine [27][28][29]. Unfortunately, plasma creatinine was not measured after the surgery.…”

Section: Discussionmentioning

confidence: 99%

Volume kinetic analysis of fluid retention after induction of general anesthesia

Hahn

Nemme

2020

BMC Anesthesiol

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Background: Induction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known. Methods: An intravenous infusion of 25 mL kg − 1 of Ringer's lactate was infused over 30 min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence. Results: Distribution of infused fluid was interrupted during the first 20 min of the infusions. During this time 16.6 mL kg − 1 of lactated Ringer's had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k 10), which remained to be very low (0.86 × 10 − 3 min − 1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k 21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate. Conclusions: Induction of general anesthesia interrupted the distribution of lactated Ringer's solution up to when 16.6 mL kg − 1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced. Trial registration: Controlled-trials.com (ISRCTN81005631) on May 17, 2016 (retrospectively registered).

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Section: Discussionmentioning

confidence: 99%

Volume kinetic analysis of fluid retention after induction of general anesthesia

Hahn

Nemme

2020

BMC Anesthesiol

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“…No role has yet been established for concentrated urine in clinical medicine, although several studies implicate its importance. For example, concentrated urine is associated with a high 30‐day mortality in acute geriatric care, 16 with more complications after hip fracture surgery, 17 and with a higher likelihood of having a rise in plasma creatinine after surgery 18 . Some evidence also indicates that concentrated urine necessitates the use of more fluid to perform fluid optimization before surgery 19 …”

Section: Discussionmentioning

confidence: 99%

Renal water conservation and the volume kinetics of fluid‐induced diuresis: A retrospective analysis of two cohorts of elderly men

Hahn

2020

Clin Exp Pharma Physio

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Renal water conservation after an overnight fast mirrors the habitual intake of liquid. The hypothesis in the present study was that water conservation influences the diuretic response to infusion of two types of crystalloid fluid. Twenty‐three elderly male patients (mean age 72 years) underwent a total of 46 intravenous infusions of 1.0 or 1.5 L of either hypotonic non‐electrolyte fluid (glycine 1.5%) or isotonic electrolyte fluid (Ringer's acetate or 0.9% saline). Urine osmolality (used to indicate renal water conservation) and plasma creatinine were measured before the infusions started. A two‐volume model was fitted to repeated measurements of the blood haemoglobin concentration and the urinary excretion, using mixed‐effects modelling software. Urine osmolality was examined as a potential covariate to the fixed kinetic parameters. The results show that distribution and redistribution of infused fluid occurred twice as fast for the non‐electrolyte fluids as for the electrolyte‐containing fluids, while the urine flow showed less difference. For both types of fluid, high urine osmolality served as a statistically significant covariate to the rate constant describing urinary excretion. Simulations showed that a high pre‐infusion urine osmolality doubled the time required for the kidneys to excrete 50% of a 30‐minute infusion. High plasma creatinine independently prolonged the elimination of non‐electrolyte fluid. The use of 0.9% saline instead of Ringer's prolonged the excretion of electrolyte‐containing fluid. In conclusion, renal water conservation is a determinant of the diuretic response to crystalloid fluid, regardless of whether the fluid contains electrolytes, and it should be considered in fluid balance studies.

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“…Many volunteers did not comply with this instruction and, in retrospect, one might even question its importance ( Fig 3D ). In a previous study, a 2-hour intravenous infusion of 500 ml of crystalloid fluid only reduced the FRI score by less than 1 step [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The analysis is non-invasive and relatively easy to perform. The fluid retention scores show a low week-to-week variability [ 7 ] and small hourly changes in the perioperative setting [ 19 ]. Limitations include the ability of the subject to provide a urine sample, which should be adequately timed for optimal predictive performance [ 22 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study

2016

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ObjectiveRenal conservation (retention) of fluid might affect the outcome of hospital care and can be indicated by increased urinary concentrations of metabolic waste products. We obtained a reference material for further studies by exploring the prevalence of fluid retention in a healthy population.MethodsSpot urine sampling was performed in 300 healthy hospital workers. A previously validated algorithm summarized the urine-specific gravity, osmolality, creatinine, and color to a fluid retention index (FRI), where 4.0 is the cut-off for fluid retention consistent with dehydration. In 50 of the volunteers, we also studied the relationships between FRI, plasma osmolality, and water-retaining hormones.ResultsThe cut-off for fluid retention (FRI ≥ 4.0) was reached by 38% of the population. No correlation was found between the FRI and the time of the day of urine sample collection, and the FRI was only marginally correlated with the time period spent without fluid intake. Volunteers with fluid retention were younger, generally men, and more often had albuminuria (88% vs. 34%, P < 0.001). Plasma osmolality and plasma sodium were somewhat higher in those with a high FRI (mean 294.8 vs. 293.4 mosmol/kg and 140.3 vs. 139.9 mmol/l). Plasma vasopressin was consistently below the limit of detection, and the plasma cortisol, aldosterone, and renin concentrations were similar in subjects with a high or low FRI. The very highest FRI values (≥ 5.0, N = 61) were always accompanied by albuminuria.ConclusionFluid retention consistent with moderate dehydration is common in healthy staff working in a Swedish hospital.

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Fluid Retention is Alleviated by Crystalloid but Not by Colloid Fluid after Induction of General Anesthesia: An Open-Labeled Clinical Trial

Abstract: Background: Renal fluid conservation, which is possible to quantify by urine analysis, is often caused by dehydration. The present study aimed to determine whether such fluid retention could be reversed by crystalloid and/or colloid fluid during surgery.

Cited by 8 publications

References 15 publications

Volume kinetic analysis of fluid retention after induction of general anesthesia

Volume kinetic analysis of fluid retention after induction of general anesthesia

Renal water conservation and the volume kinetics of fluid‐induced diuresis: A retrospective analysis of two cohorts of elderly men

Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study

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